ࡱ>   gbjbjcTcT 46>>J^+f f    8E4y  7aaav7x7x7x7x7x7x79W<tx7a?"aaax77E&E&E&a8v7E&av7E&E&V.@.GP F. b7707R.x<<.<.aaE&aaaaax7x7E&aaa7aaaa<aaaaaaaaaf o: NORTHERN IRELAND AMBULANCE SERVICE  Present: Mr P Archer ChairmanMr L McIvorChief ExecutiveMr F HughesNon-Executive DirectorProf M HanrattyNon-Executive DirectorMr N McKinleyNon-Executive DirectorMr S MullanNon-Executive DirectorMr B McNeillDirector of OperationsMs R OHaraDirector of Human ResourcesDr D McManusMedical DirectorMrs S McCueDirector of Finance In Attendance: Mr R DixonArea Manager, Patient & Client CouncilMrs M CrawfordExecutive AdministratorMs K BaxterSenior Secretary 1.0ApologiesMr S Shields, Non-Executive Director.2.0Welcome and Format of the MeetingMr Archer opened the meeting by welcoming members of the public and Trust Board and explained the arrangements for receiving questions from the public attending. He also welcomed Mr Dixon from the Patient & Client Council (PCC). Mr Dixon advised that he is the Belfast Area Manager and is due to attend all NIAS public Board meetings. He would like to raise questions during discussions, however he confirmed that he will not be involved in the decision making of the Board. The Board is content with this level of engagement and welcomed Mr Dixons involvement in the Public meetings. Mr Dixon thanked the Board for agreeing to the arrangement.3.0Minutes of the Previous Meeting of the Trust Board held on 24 September 2009Members accepted the minutes as a true and accurate record of proceedings on the proposal of Mr Hughes seconded by Mr McKinley subject to the following amendments: Pg.3 Last paragraph Mr Mullan noted the drop in the monthly category in the Northern area. Sentence should read: Mr Mullan noted the drop in the monthly figures for category A in the Northern area. Pg.4 End of Operations performance report. Additional sentence to read: Whilst Mr Mullan noted the response times reported, he expressed concern in the Trusts ability to breakeven if the use of overtime continues. Pg.6 HR03 - Business Case submitted to DHSSPS. Sentence should read: Outline Business Case submitted to DHSSPS. Pg.7 Second line He was advised that in relation to the introduction of KSF and that the Trust is on line .... Sentence should read: He was advised that in relation to the introduction of KSF that the Trust is on line ....4.0Matters Arising4.1NIAS Governance ArrangementsMr Archer updated the review of governance arrangements and advised that a further workshop is to be held on Wednesday, 2 December 2009 facilitated by the Beeches Management Centre. 4.2Efficiency Savings and Comprehensive Spending Review Investment ConsultationNIAS are implementing efficiency savings in line with Ministerial direction and engagement has been ongoing with Trade Unions. Phase 2 is on target for the 1 December 2009 with further reconfiguration of A&E and RRV. The situation will be monitored paying close attention to all aspects of performance. Mr McIvor commended the work of Managers and those who have led the changes. The Trust is aware of the impact these changes will have on staff. Mr Archer commented that to implement 2 years of savings in a short period of time is an enormous task for the management team requiring huge input from all but particularly HR and Operations.4.3Review of Records Management Policy to reflect Boards Comments Mrs McCue began by stating that this item relates to the Retention and Disposal Schedule which was presented at the last Board meeting. This Schedule is a standard document which has been signed by the Chief Executive and the DHSSPS and has been presented to the Public Record Office for approval (who commended the Trust on the document). The Retention and Disposal Schedule had been developed to comply with legislation. Mrs McCue stated that Patient Report Forms which are the Trusts main source of information on patients will be kept for a period of 26 years. This complies with legislative requirements for all patients whilst recognising that we could not easily or confidently determine the verified age or mental status of all of our patients at the time of record completion. Professor Hanratty requested that the detail of record retention for each type of patient be specifically identified. Mrs McCue agreed to advise the Trust Board at the next meeting. Action: Mrs McCue, Director of Finance.5.0Chairmans Business5.1Visit to Lisburn Station Mr Archer noted that this is a very busy station. He spoke with staff who he considered had a good attitude to their work. The facilities are generally good; however space was limited in some areas with little storage. Outside washing facilities present an issue if the weather is poor. Staff raised the issue of calls to Maghaberry Prison and the interplay between security and patient care. They were concerned about the delay in getting patients to hospital. It was noted that there is no record of any adverse outcomes for patients arising from such incidents and the Prison does have medical staff and facilities to provide treatment to prisioners. It was noted that NIAS have been involved in exercises with the Prison Service. A further issue was raised by staff regarding the transfer of patients to trolleys in A&E Depts. It was advised that NIAS invested some years ago in hydraulic trolleys, however there is no consistency within Trusts and each have their own procurement process. It could improve the patient experience if trolleys were standardised throughout. It was further advised that the future of the site was uncertain as the area is being earmarked for a new Health Centre. The situation will continue to be monitored, and NIAS has advised of the need to maintain an ambulance base in the Lisburn area.5.2Proposed Trust Board & Committee Schedule 2010 The following was noted: Mr Mullan would not be available for: 28 January, 6 May 2010. Prof Hanratty would not be available on the 28 January, 27 May and the 25 November 2010. It was requested that consideration be given to changing the January, May and November dates.5.3Chairmans Update Mr Archer gave a brief outline of his diary commitments since the last Board meeting. Governance Workshop 8 October 2009 2 planning meetings (Governance Arrangements) with Mr Nixon, Consultant, Beeches Management Centre. Meeting with Mr McIvor/Mrs McCue regarding practicalities of getting minutes agreed for Committees. Meeting with Trust Chairs and Local Commissioning Group Chairs Meeting with NICON Chairs Mr Archer also continues his weekly meetings with Mr McIvor.6.0Chief Executives Business6.1Chief Executives Update Mr McIvor briefed members on current issues: Met with the Health Committee on the 1 October 2009. Attended a Territorial Army Medical Presentation on the 4 November 2009 where the Trust was presented with a print. Mr McIvor was accompanied by a member of staff who had served in Afghanistan. Met with Mr McFarland (representing Lady Hermon) along with other MLAs from the Ards Peninsula on the 6 November 2010. This was a robust engagement and it was an opportunity for NIAS to explain what the Trust is seeking to achieve and the resources available to deliver care. Telephone conversation on the 10 November 2010 with the Irish News regarding an item they had printed where it stated that NIAS failed to respond within 8 minutes for almost all of its call-outs. NIAS is to engage further with the Health Correspondent and an invitation has been extended for them to visit our Control Room to enhance their understanding of the Service. Met with the Permanent Secretary, Mr Andrew McCormick regarding the NIAS Performance and Accountability Review. The Trust was commended on current response performance and our efforts to achieve financial breakeven. Mr Archer commented on the NICON weekly bulletins where a link to the Hansard report on the meeting between NIAS and the Health Committee was available, which was favourable for NIAS. It was noted that Non Executive Directors do not receive these bulletins. Action: Non Executive Directors to be included in mailing list for NICON and NHS Confederation Bulletins.7.0Performance Reporting as at 31 October 2009OPERATIONS Mr McNeill updated members advising members that the charts presented have been altered since the last Board meeting to make them more user friendly. Mr McNeill set the context for the Operations report advising the Board that activity levels across Northern Ireland had increased by 8% from October 2008. He highlighted that there were significant increases in both the Northern Division (13.2%) and the Western Division (13%). Southern Divisions activity had increased by 8.5% and the Eastern Division by 4%. OP1 - Mr McNeill was pleased to report that the Trust was currently achieving the 70% PFA target and indeed the 72.5% year end target for the month of October and the 62.5% LCG target was also being achieved in all divisions. He highlighted to the Board that Year 1 efficiencies, that is the removal of the equivalent of 2 24/7 A&E vehicles took effect from 1 November 2009 and plans were in place to move to Year 2 efficiencies with the removal of a further two 24/7 A&Es across Northern Ireland. However these reductions will be more than offset by the planned increase in RRV hours. In relation to Paramedic Rapid Response NIAS has now built up cover to provide 22 responding units. They are contributing 29.5% to the Category A8 target. Given that NIASs ability to transport patients has been a concern during the EQIA consultation on the efficiency savings Mr McNeill reported that 94.5% of patients who made a 999 call were transported within the 18/21 minutes standard. Focusing on the individual areas, Belfast continues to be a high performer with 85%. Northern and Southern Divisions have experienced a slight drop in performance due to diverts operating in the area. Mr McNeill took the opportunity at this point to thank Managers, staff and Union representatives for the work that was undertaken to prepare for the introduction of Year 2 efficiencies from 1December 2009 particularly in respect to changes to rotas. OP2 There was no change in the trend as presented. OP3 Mr McNeill advised that this still represents a large proportion of work for the Trust, over 3,000 calls per month, which represents about a 1% increase from last year. He further advised that the Intermediate Care vehicles are now dealing with 21% of these calls and that their contribution is essential if the Trust is to maintain and improve on response targets. OP4 All of the new A&E vehicles are now operational. The build programme for the new 24 A&E vehicles for this year 2009/10 is on target with the first two vehicles expected in the new year and two per week coming off production line for each week thereafter. Plans are in place to progress with the conversion of four Renault Master vehicles for PCS and 10 RRV cars are being procured. OP5 Work is now in progress to install an additional deployment point at Coalisland and a deployment point is now open in Holywood. This is a shared facility with the Northern Ireland Fire and Rescue Service. An estate addendum has been forwarded to the Department to support OBC1 Capital Investment Programme. This addendum is to support the release of funds to take forward a design team to support this project. FINANCE Mrs McCue updated members highlighting the following: FN01 The Trust was previously reporting 1.5m deficit by year end however progress has been made during meetings with Commissioner and the Trust is now reporting a breakeven position at year end. Assumptions are being reviewed on an ongoing basis. FN02 Phase 1 is in place with Phase 2 beginning on the 1 December 2009. On track to achieve. FN03 This is a concern for other Trusts, however NIAS own little estate with the majority of premises being rented. FN04 The Trust is currently achieving 94.6% at present. This area continues to be a focus for the Finance Department. FN05 Capital spend has been reduced by 1.5m with a further 1m of capital funding being removed from the 2009/10 funding allocation. This reduction, coupled with the absence currently of approval for the fleet business case means that the Trust is unable to progress the planned replacement this year of 24 PCS vehicles and 13 RRV support vehicles. FN06 On track to achieve. FN07 On track to achieve. FN08 - On track to achieve. These are requests from the DHSSPS for oral or written assembly questions. In October 2009, 38 written questions were received. Mrs McCue commended the team within her own Directorate and others across the Trust who contribute to the responses. Prof Hanratty enquired about the type of questions being asked. It was advised that they cover a wide range of areas for example Management structure, administration costs, IT spend, HR spend, Finance spend and CSR proposals. Mr Mullan asked if the Trust received extra funding and was informed that although no specific funding was made the Trust did receive some investment in the area of IT and Information. MEDICAL DIRECTORATE Dr McManus updated members highlighting the following: MD01 Roll out of Thrombolysis continues and training is to be completed by December 2009. Hardware to facilitate the transmission of the ECGs has been identified and procured and installation is to be completed by December 2009. Meetings have taken place with hospitals and all but one has agreed to receive ECG transmissions. MD02 No incidents of healthcare acquired infections reported. NIAS takes this matter very seriously and a number of the recommendations from the Healthcare Associated Infection (HCAI) report have been implemented. Since the last Board meeting NIAS has met with the Northern Ireland Practice and Education Council (NIPEC) who now make up part of the expert group. Infection prevention and control is included in update training currently being delivered. Through the Clinical Governance Committee and the Infection Control Group systems have been established for vehicle cleaning. MD03 Formal standards were adopted by the Board at the last meeting and have been circulated to staff. These standards will be included in refresher and induction training. NIAS is working with the Board and other HSC Trusts in developing a consultation scheme. Draft Consultation will be presented to the Board. MD04 NIAS continues to work with other Trusts regarding pre hospital care. Stroke patients continue to be fast tracked to hospitals providing thrombolysis. MD05 Nineteen Clinical Support Officers have been appointed and are due to commence training. MD06 Some problems are still being experienced in this area. Full roll out has been delayed however NIAS is hopeful that this matter will be resolved in the near future. MD07 NIAS continues to participate in regional planning for major incidents and pandemic flu. Mr Archer asked why 7 ambulances and 4 RRVs were in attendance at an airport alert for a small plane carrying two persons. Dr McManus advised that they must prepare for the worst case scenario in the event that the aircraft would crash in a built up area. HUMAN RESOURCES Ms OHara updated members highlighting the following: HR01 Ms OHara was pleased to advise that the absence figures for September are currently 6.59%. She added that a huge amount of work is being carried out by the HR and Operations Directorate. Performance Management tools have been introduced and referrals to Occupational Health are being carried out within 2 weeks of referral. A review of the Absence Policy is ongoing which will bring it into line with the other 5 Trusts. Mr McIvor added that this issue was raised at the Accountability Review meeting held at the DHSSPS where it was suggested that benchmarking take place against UK Ambulance Services absence figures which would give a more realistic comparator for NIAS. Ms OHara advised that absence figures for Ambulance Services would historically be higher as early retirement is not available. If the retirement age was available at 55 there would be a reduction is absence figures. Prof Hanratty asked if there were any trends in relation to male or female and was advised that there were no trends identified. HR02 On target to achieve. Mentoring in clinical practice completed. Mandatory CPD training includes good relations, fraud, complaints and records management. Mr McIvor commented that the Vision and Core Values of the Service with an emphasis on staff to deliver the best care possible are also included. Mr McKinley asked how performance assessment will change and was advised that there is a change in the emphasis and that professional standards are now in place to deliver more elaborate training. HR03 Title incorrect should read as Undergraduate Diploma in Paramedic Science On target to achieve. Work ongoing. A meeting of the Project Board is to be held Monday, 14 December 2009. HR04 On target to achieve. Regional Project Manager is finalising action plan for the implementation of the Knowledge and Skills Framework (KSF). An audit of post outlines has been carried out within the Trust with 75% being completed. The position of a Staff Side KSF Lead is now vacant and NIAS is awaiting a response from the Unions. A national review has been completed and the findings will be available by March 2010. HR05 58 complaints have been received from April 2009. Mr Archer commented that it was useful to get a complete picture of complaints received since April 2009 which is a relatively small number compared to the number of calls dealt with by the Service. Mr Hughes asked if there was a trend as 31% of complaints were in relation to staff attitude. It was advised that on occasion this is the case, however it can be the patients perception. Another factor is PCS not delivering patients on time for appointments and this can be difficult to explain eg an urgent call being given priority. The Emergency Callers can also appear to be abrupt; however they are focused on getting the correct information from the caller as quickly as possible. Mr Mullan enquired if any monitoring of teams or individuals is carried out for any patterns emerging. All information is now held on the DATIX system which links all information relating to staff or patients which will identify patterns or trends. Mr Dixon welcomed the discussion on complaints by the Board and hoped that the 5 Personal & Public Involvement (PPI) standards introduced will show their worth. He added that the PPI agenda will allow for other forms of dialogue where people may have questions rather than complaints. Mr Archer commented that NIAS had received approximately the same amount of compliments as complaints. Prof Hanratty noted that all reports presented were fairly comprehensive and asked why there is no report on HR matters such as recruitment and disciplinaries. It was advised that a 6/12 monthly analysis is presented to the Board, as specifically requested by the Board when considering HR reporting prior to Professor Hanrattys appointment, with the last one being presented in June 2009. Ms OHara commented that some of this information is captured within the other performance reports. She was however uneasy regarding the issue of disciplinaries where some of the Board members may be required to sit on disciplinary panels, as there is also an issue of confidentiality. It was considered that statistics could be presented rather than the details of cases. Mr McKinley said this would be useful to show the quantity of activity and make the Board aware of potential tribunals. It was agreed that Ms OHara and Mr McIvor would look at the performance reports and develop proposals for the Board. Action: Ms OHara/Mr McIvor. 8.0Patient & Client Council Noted.9.0Policies /Procedures (for approval) 9.1Risk Management Strategy An Assurance Framework 2009 2013 The Risk Management Strategy was reviewed in light of communication received from the DHSSPS. This will be presented in detail to the Risk Management Committee due to be held 3 December 2009. Some changes were required within the procedure rather than the policy where editorial changes only were required. Mr Mullan highlighted the Terms of Reference; Pg.5 paragraph 5.3 and 5.4 where it states The Clinical Governance/Audit Committee will be responsible for assuring the NIAS Board that effective and regularly reviewed arrangements are in place to manage those financial risks to which the Trust is exposed. He stated that the Non Executive Directors can only review arrangements and make recommendations as they have no Executive authority. He added that he would be writing to DHSSPS in this regard as Chair of the Audit Committee. Mr McIvor stated that following correspondence with the DHSSPS that clarity may be received which can then be reflected in the document. Mr Mullan agreed to provide a draft to the Audit Committee before sending to DHSSPS which will be shared with the Secretariat for circulating to the Board to establish an audit trail. it was agreed that the document would be adopted by the Board (proposed by Mr McKinley seconded by Mr Hughes) and that any changes necessary thereafter would result in revisions coming to the Board as appropriate. Action: Mr Mullan/Mrs Crawford. 9.2Infection Prevention & Control Policy Dr McManus presented the draft document for approval by the Board. RQIA have had sight of the document and have suggested a a few minor amendments. A meeting has been arranged to discuss and the policy will be presented to the Clinical Governance Committee. Mr Mullan queried whether the Board can approve the policy when amendments are still required. He also noted that the Whistle Blowing Policy was not mentioned. Dr McManus advised that information on Whistle Blowing can be included within the document. After further discussion it was agreed that the document would be approved by the Board (proposed by Mr McKinley seconded by Mr Hughes) subject to further changes being made by the Clinical Governance Committee under Chairs Action. Action: Prof Hanratty, Chair of Clinical Governance.9.3Complaints Policy Ms OHara presented the Complaints Policy advising that the policy was reviewed under guidance from the DHSSPS and was subject to full consultation. She added that the Complaints Procedure will also be amended to reflect the PPI standards. Some discussion ensued and it was agreed that Ms OHara would send the Complaints Procedure to Mr Dixon to enable him to make comments. The Complaints Policy was adopted on the proposal of Dr McManus seconded by Mr McKinley. Action: Ms OHara to forward Complaints Procedure to Mr Dixon for comment. 10.0Policies / Procedures (for approval) 10.1 Mid Year Assurance Statement This document was presented to the DHSSPS and the Permanent Secretary. 10.2 Minutes of Audit Committee held 18 September 2009 Noted. 10.3 Ambulance Today NIAS first NHS Centre to achieve BTEC Award This is a positive news story for NIAS and the Trust was pleased to receive recognition through Ambulance Today. 11.0Application of Trust SealThe Trust Seal has been used on one occasion. This was for a small rental increase for the Ambulance Station at Roe Valley.  12.0Forum for QuestionsNo questions received from the floor. 13.0Any Other BusinessNo other business. Date, Time and Venue of Next MeetingThe next meeting of the Trust Board will be held in the Southern Division, date and venue to be confirmed. Mr Archer thanked those present for attending and called proceedings to a close. 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